Verify: Can an app replace a trip to the eye doctor?

There are apps for everything—including, checking your vision.

Author:
Sonia Azad

Published:02/02/18

There are apps for everything—including, checking your vision.

It’s a sore spot for a lot of eye doctors who are fielding tons of questions from patients about whether eye health apps are just as good as a doctor’s visit. Sometimes it’s the only option for people who don’t have insurance and just need a quick check up.

Technology has evolved quite a bit in the last 25 years. Machines have replaced people at grocery stores, in our own news studio, but what about replacing a visit to the eye doctor?

We spoke with Dr. Amanda Hoelscher, an optometrist at Key Whitman Eye Center, dug up research from The University of Texas Medical Branch in Galveston, and went woman-versus-machine to verify.

“I think some of the apps are actually fairly accurate if you have a reasonable prescription,” Hoelscher said while she checked the vision prescription for WFAA's Health and Wellness reporter Sonia Azad.

Then, Azad used one of many free apps to check Dr. Hoelscher’s work. Everything matched up.

“That's not really the problem with using the app,” Hoelscher said. “20/20 doesn't mean that you don't have glaucoma, it doesn't mean you don't have cataracts, it doesn't mean that you don't have macular degeneration.”

Hoelscher said what you really need every year is a comprehensive eye exam.

“When we perform a comprehensive eye exam, we're always checking your eye pressure, we're looking at the health of the eye. We're looking at the cornea, we're looking at the lens, we're looking at the retina. The apps are not going to catch those things,” Hoelscher explained. “Even if you have good vision, there are things that are detected through a comprehensive eye exam that have nothing to do with prescription.”

And, the app makers are smart. Before you can take their vision tests, they all have disclaimers spelling out that they are not a substitute for a “comprehensive eye exam.”

Telemedicine has been studied since the 1990s. But, the purpose was never to replace face-to-face consultations, according to a study conducted by researchers at UTMB Galveston. Scientists were trying to develop ways to screen for illness or disease. It’s why we’re getting better at detecting problems earlier. And, in emergencies or in rural countries where medical attention isn’t available, it might be the best option… because it’s the only option.

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“My first patient today… would've easily passed on one of the apps. Easily,” Hoelscher said. “But during her exam, she has very severe dry eye that we're treating medically. That would've been missed by an app. And left untreated, it would've sustained permanent damage."

So, back to our Verify question: Is an eye health app just as god as an annual visit to your eye doctor? No. while the apps can offer you the same basic protection, it’s still false. It seems technology can’t really replace everyone.

We spoke with several optometrists who all said the same thing: don’t rely on an app if you have an astigmatism or a unique prescription. Apps are also not a suitable way to check eyesight in children. The wrong eyeglass prescription could affect the way their eyes develop.

We asked three more optometrists in North Texas about their thoughts on eye health apps. Here’s what they had to say:

Ashley Hemmati, OD

“They most definitely do not replace an annual eye exam. Let's start with the applications that "refract" you. (This is when we're trying to figure out the patient's prescription, aka "which one is better 1 or 2".) Whether something is clearer to someone is very subjective, which is why in our charts we label these findings "subjective refraction.” There is definitely an art to prescribing glasses/contacts and a lot to consider. One example: you don't want to make any big changes to a current prescription. Making huge jumps could lead to discomfort for the patient who would have a hard time adapting to the glasses, and therefore not wear them. This could possibly lead to a safety issue, especially if the patient has a restricted license (i.e. they should be driving with vision correction). You'd be surprised by the number of patients that are driving on the streets without proper vision correction, and are not meeting the proper visual acuity to legally drive.

Also, when I see my patients, not only am I focusing on determining their prescription, I'm examining the anterior and posterior of the eye to make sure there are no infections, inflammation, or possible diseases. A lot of contact lens wearers are not compliant with their lenses: sleeping in their contacts, not replacing the lenses when needed, and simply wearing them too many hours in the day. Doing these things can cause corneal ulcers, inflammation/swelling of the cornea, infections, etc. If patients are able to do an "eye exam" on an app and order contacts without having a professional take a look at the health of the eye, that patient is putting their eyes at risk, potentially causing them to have permanent vision loss. I always explain to patients that permanent vision loss means glasses and contacts will not improve your vision or fix it. I've had plenty of patients sit in my exam chair without knowing that they have some sort of inflammation or infection. A lot of patients don't truly understand the risks they put their eyes in when they abuse their contacts.

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As for the apps that take pictures of the posterior pole (this includes some of the blood vessels, optic nerve and the macula): these pictures only show a small part of the eye. The eye is spherical, and when we take a picture of only the posterior pole, it is missing the far edges (peripheral part) of the eyeball. There are certain patients that need to be dilated yearly: patients who have higher than a -6.50 prescription (due to increased risk of retinal detachments, holes, tears), patients who are diabetic (can have bleeding in any part of the eye), and patients who are having symptoms of flashes, floaters, and narrowing of periphery (these are signs of retinal detachments, holes, and tears). Dilation is the only way to make sure that there is nothing going on in the back of the eye. If the patient truly does have diabetic retinopathy, retinal detachment or tear, they could permanently have vision loss or worse-- blindness.”

Roshie Moshtaghfard, OD

“Technology is a great addition to our practice but it won't replace what we do. These online exams state that this does not replace an eye exam and that the patient should still see their optometrist annually, but most people won't because they are being led to believe that this online test is the same as going to their eye doctor. It is not the same and is not the standard of care. The cost of the online test is very similar to the cost of going to see your optometrist and paying your insurance co-pay for an eye exam. If you wear contacts, there is an additional contact lens evaluation fee added to that co-pay. A friend I work with took an online exam to see what her results would be versus what she wears and the final prescription was 10 degrees different in her axis of astigmatism from what she wears currently. Changing a patient’s prescription and assuming she will see great out of her new contacts is a risk, especially when a patient wears a Toric contact lens. Contact lenses are a medical device and how they fit on your cornea can change from year to year. All contacts are not the same. At our office at Uptown Vision, one of our patients ordered contacts from Hubble trying to save money. Hubble contacts are made out of a 20+ year-old lens material called Methafilcon A, which has an oxygen permeability of 18.8. Research shows that what’s necessary is 24—in order to maintain cornea health and avoid swelling. Corneal swelling can change the patient’s prescription and can be detected during the exam with the use of a slit lamp. Online exams cannot detect corneal swelling. Online exams cannot detect any type of disease that could have an impact on a patients vision/refraction and also the online exams cannot detect the medical well-being of the eye. A patient’s glasses or contact lens prescription is only a small part of an eye exam. Like people googling medical questions-- taking online exams can be misleading when compared to a one-on-one experience with your doctor.”

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Albert Pang, OD

“In medicine, we diagnose by observation, asking questions, touching, sometimes smelling. “Information from lab tests and imaging is considered to be aids to confirm certain medical conditions. In dermatology and ophthalmology, it is more difficult to utilize technology in telemedicine. I will not discredit the importance or efficacy of telemedicine in remote areas where secondary care is not that accessible. It is important for us to detect sight-threatening conditions such as glaucoma or diabetes retinopathy. However, we should not be utilizing it as a replacement to regular eye physicals. All the telemedicine instruments are designed to provide a yes or no answer. They don’t give physicians any quantitative answers (i.e. how bad is the condition). Most of the “advanced instruments” tend to give a high false negative value (under-detect certain medical conditions) which can give a false sense of security to patients who may already be experiencing symptoms of a disease not detected by telemedicine instruments. Like all physicians, I have experienced times when advanced diagnostic equipment failed to detect certain medical problems. But we save a person’s sight because we insist on our judgment, and often can discover conditions that advanced equipment fails to detect.